半夏(洗) 桂枝(去皮) 甘草(炙)
上三味等分。各别捣筛已。合治之。白饮和服方寸匕。日三服。若不能散服者。以水一
升。煎七沸。内散两方寸匕。更煎三沸。下火。令小冷。少少咽之。
少阴病。咽中痛。半夏散及汤主之。按少阴咽痛。大都上热下寒。不宜寒凉直折。本方
用半
夏开痰。桂枝散邪。复甘草以缓其急。使无劫液之虞。能咽者用散。不能咽者用汤。须令小
冷。少少咽之。此病在上者。但治其上。不欲其犯及中下也。
猪肤(一斤)
上一味。以水一斗。煮取五升。去滓。加白蜜一升。白粉五合。熬香和令相得。温分六
服。
少阴病。下利咽痛。胸满心烦者。猪肤汤主之。按下利咽痛。有阴盛而阳格于上者。治
以驱
阴复阳。若通脉四逆加桔梗是也。有阴虚而液不上蒸者。治宜育阴复液。若本方猪肤汤是也
。
肾液既从下溜而不上蒸。则阴火充斥。因致烦满。故以猪肤滋肾脏之液。而缓以白蜜白粉
。留恋中焦。输精布液。以解其上征下夺之危。
喻嘉言曰。猪肤与用黑驴皮之意颇同。若以 猪皮外毛根薄肤。则 劣无力。且与熬香
之说不符。但用外皮。去其内层之肥白为是。
甘草(二两)
上一味。以水三升。煮取一升五合。去滓。温服七合。日二服。
少阴病二三日。咽痛者可与甘草汤。按咽痛而不下利。得病只二三日。是邪热客于少阴
之标也。少阴咽痛。总不宜苦寒。直折。故但取甘草之甘。以缓肾急而制火邪也。
半夏(洗净) 桂枝(去皮) 甘草(炙烤)
以上三味药,分量相等。分别捣碎并过筛后,混合均匀。用米汤调和,每次服用一方寸匕的药散。每日服用三次。如果患者无法直接吞服散剂,则取水一升,煮沸七次后,加入两方寸匕的药散,再煮沸三次,离火,待药液稍凉后,少量多次地咽下。
少阴病(少阴经受邪所致的病证),咽喉疼痛,使用半夏散及半夏汤主治。按:少阴病的咽痛,大多属于上热下寒证,不宜直接用寒凉药物直折其热。本方用半夏化痰开结,桂枝疏散外邪,再用甘草来缓解急迫,从而避免劫伤津液的担忧。能够吞咽的,使用散剂;不能吞咽的,使用汤剂。必须让药液稍凉,少量多次地咽下。此病位在上焦,只需治疗上焦,不希望药力波及中焦和下焦。
猪肤(一斤)
以上一味药,用水一斗,煮至剩余五升,滤去药渣。加入白蜜一升、米粉五合,熬至香气溢出并混合均匀。温热时分为六次服用。
少阴病,出现腹泻、咽喉疼痛、胸部胀满、心烦等症状的,使用猪肤汤主治。按:腹泻伴咽痛,有因阴寒内盛、阳气被格拒于上的情况,治疗应以驱除阴寒、恢复阳气为主,如通脉四逆汤加桔梗即是此类。也有因阴虚、津液不能上承蒸腾的情况,治疗宜滋养阴液、恢复津液,如本方的猪肤汤即是此类。
肾中的津液既然从下部流失而不能上承蒸腾,导致虚火充斥体内,因而产生烦闷和胀满。因此用猪肤滋补肾脏之津液,并用白蜜和米粉缓和药性,使其留恋于中焦,输送精气、布散津液,以解除上部火热、下部津液亏损的危局。
喻嘉言说:猪肤与使用黑驴皮(阿胶原料)的意思颇为相同。如果用带毛的猪皮或仅取薄皮,则药效薄弱无力,且与“熬香”的说法不符。只应使用外皮,去掉内层肥腻白色的部分才是正确的。
甘草(二两)
以上一味药,用水三升,煮至剩余一升五合,滤去药渣。温热时服用七合。每日服用两次。
少阴病发病两三天,出现咽喉疼痛的,可以给予甘草汤治疗。按:咽痛而没有腹泻,患病仅两三天,这是邪热客居于少阴经的标部所致。少阴病的咽痛,总不宜使用苦寒药物直折其热,因此只取甘草的甘缓之性,来缓解肾脏的急迫并制约火邪。
Banxia (Pinelliae Rhizoma, washed) Guizhi (Cinnamomi Ramulus, bark removed) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried)
The above three ingredients are used in equal proportions. Each is separately pounded and sifted, then mixed together. Mix with rice water and administer one fangcun bi (a square-inch measure) of the powder per dose. Take three times a day. If the patient cannot take the powder directly, add two fangcun bi of the powder to one sheng (approx. 200ml) of water, boil seven times, then boil three more times. Remove from heat, allow to cool slightly, and swallow in small amounts frequently.
Shaoyin disease (disease pattern involving the Shaoyin channel), characterized by sore throat, is primarily treated with Banxia San and Banxia Tang. Note: Sore throat in Shaoyin disease mostly presents as upper heat and lower cold, and should not be treated with direct cooling agents. This formula uses Banxia to resolve phlegm, Guizhi to disperse pathogenic factors, and Gancao to relieve urgency, thereby avoiding the risk of damaging body fluids. For those who can swallow, use the powder; for those who cannot, use the decoction. The medicine must be allowed to cool slightly and swallowed in small amounts frequently. Since the pathology is located in the upper jiao, treatment focuses solely on the upper jiao, avoiding interference with the middle and lower jiao.
Zhufu (Porcine Skin, one jin)
The above single ingredient is boiled in ten dou (approx. 2L) of water until five sheng remain. Strain the dregs. Add one sheng of white honey and five he (approx. 100g) of white flour (rice powder). Cook until fragrant and well combined. Take warm, divided into six doses.
Shaoyin disease presenting with diarrhea, sore throat, chest fullness, and irritability is primarily treated with Zhufu Tang. Note: Diarrhea accompanied by sore throat may result from yin excess repelling yang to the upper level; treatment aims to drive out yin and restore yang, such as Tongmai Sini Jia Jiegeng Tang. Alternatively, it may result from yin deficiency where fluids fail to ascend and steam upward; treatment should nourish yin and restore fluids, such as this Zhufu Tang.
When kidney fluids flow downward instead of ascending and steaming upward, deficient fire fills the interior, causing irritability and fullness. Therefore, Zhufu nourishes the fluids of the Kidney organ, while white honey and rice powder moderate the action, retaining them in the middle jiao to transport essence and distribute fluids, resolving the crisis of upper heat and lower fluid depletion.
Yu Jiayan stated that the rationale for using Zhufu is similar to that of using black donkey-hide gelatin. Using pig skin with hair roots or thin skin would be weak in efficacy and inconsistent with the instruction to "cook until fragrant." It is correct to use only the outer skin, removing the inner fatty white layer.
Gancao (Glycyrrhizae Radix et Rhizoma, two liang)
The above single ingredient is boiled in three sheng of water until one sheng and five he remain. Strain the dregs. Take seven he warm. Take twice a day.
In Shaoyin disease, if sore throat appears within two to three days of onset, Gancao Tang may be administered. Note: Sore throat without diarrhea, occurring only two to three days after illness onset, indicates pathogenic heat lodging in the branch aspect of the Shaoyin channel. Sore throat in Shaoyin disease generally should not be treated with bitter-cold agents to directly suppress heat. Thus, only the sweet nature of Gancao is utilized to relieve Kidney urgency and control fire pathogens.